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Saturday, November 4, 2017

The New VA Appeals Process - RAMP

The VA has officially started their renovation of the VA appeals
process—hooray!

However, it isn’t quite time to celebrate for everyone. The
VA’s new RAMP (“Rapid Appeals Modernization Program”) will only be available by
invitation until the full program is implemented sometime before February 2019.

Starting this month (November 2017), the VA will be sending
out RAMP invitations to eligible veterans with pending VA appeals. The invites
won’t go out to everyone, so even if you are “eligible” and have had your
appeal pending for a while, it doesn’t mean you’ll get one.

The VA’s goal is to slowly grow this program over the next
year or so until it can support the full load of every veteran’s appeal. Thus,
they’ll be regularly sending out invites throughout the year, and once their
infrastructure is solid enough, they’ll open the RAMP program up for everyone.

So what does this mean for you?

If you have not yet submitted
an appeal, then you can submit your appeal using the current VA appeals process. You cannot yet apply directly to the RAMP program as invitations are
only going out to veterans who already have their VA appeals pending. Sometime
before February 2019, the VA will open up the RAMP program to new appeals as well,
but there is no way to know exactly when, so you have to still apply via the
current system. Although, once your appeal is in the system and pending, you
might get a RAMP invite.

If you have already submitted
a VA appeal, then just sit back and wait. You might receive a RAMP
invitation sometime this coming year, but there is nothing that you can
actively do right now.

If you receive a RAMP
invitation, then you have the option to choose whether to participate in
the new RAMP process or to leave your appeal in the old process. Either way
could be fine, depending on your case, and it is completely up to you.

The goal of RAMP is to make the VA appeals process faster,
so it may be in your best interest to switch to RAMP. However, if you’ve been
pending for awhile and your case is more complicated, it may be better to stay.

Under RAMP, you have the ability to choose one of three
“lanes” to put your appeal in. If you pick the best lane for your type of case,
then it will be reviewed much more quickly than the current system. If,
however, you pick the wrong lane or it is too complicated for a particular
lane, it will then be transferred to the other lane or the BVA’s longer line.

Even under RAMP, more complicated cases must go to the Board
of Veterans Appeals (BVA), but the BVA will not be reviewing any RAMP cases
until February 2019. Until then, the BVA will simply focus on the pending
appeals in the current system.

It’s important that you understand the types of cases that
should be put in each lane so that you make the best decision for your VA
appeal:

1.Local
Higher Level Review.This lane is
for cases that don’t have any new evidence and are fairly straightforward. If
the VA made an error and the evidence in the claim clearly proves their error,
then this is the lane for you. The majority of appeals that don’t have new
evidence will be fine in this lane.

2.New
Evidence. This lane is for claims that have new evidence that wasn’t
submitted with the original claim. If the VA made a decision about your case,
but didn’t have all the evidence and you’d like to submit additional evidence,
then this is the lane for you. Only submit to this lane if you have new
evidence regarding your conditions that the VA has not yet seen.

3.The Board.
This lane sends a case directly to the Board of Veterans’ Appeals (BVA). Again,
however, the BVA will not be reviewing cases under RAMP until February 2019 as
they are already overwhelmed under the current system and need to focus on
that.

So until the RAMP program is fully implemented, only the
first two lanes will be beneficial. If you decide to participate in the RAMP
program under one of the first two lanes, and disagree with their decision,
then you can appeal directly to the BVA.

As the BVA will be focusing on the current appeals, it is
definitely fine to choose to not participate in the RAMP program. Depending on
your case, however, the RAMP program may be a godsend. In reality, the majority
of VA appeals are fairly straightforward cases that are simply bogged down in
the overload of the current system. This new RAMP system will allow those cases
to be separated out and reviewed more quickly.

Ultimately, the VA’s new RAMP program should make the VA appeals process much better in the long run by dividing the labor among three
lanes instead of it all landing on the BVA. However, it will take some time to
fully implement and be available to everyone. Hopefully during that time,
they’ll be able to work out the kinks and have a solid system ready to go by
February 2019.

192 comments:

Quick question on heart arrhythmias -- I am on active duty and currently seeing a cardio specialist for episodes of possible arrhythmia (racing of the heart, accompanied by occassional light headedness). Echocardiogram shows MILD regurgitation; Stress test shows some arrythmia; CAT Scan of heart and circulatory system shows some calcification (score of 56) and the heart monitor shows arrhythmia but not close enough in episode to cause concern; however referred to electrophysiologist. What questions should I ask, what should I look for? And, what is the potential for disability rating; more importantly how COULD this affect my active duty status?

I don't have enough information to really know just how much this condition affects your ability to do your job. Are you able to fully perform all the duties of your MOS? Are you able to be deployed? Since the condition is recorded as mild, the arrhythmia may not yet be severe enough to limit your performance, and so you may still be considered fit for duty for some time. Only if you have episodes regularly which limit your ability to work would the docs (or your commander) feel that your condition is severe enough to make you unfit for duty.

http://www.militarydisabilitymadeeasy.com/unfitforduty.html

As for a disability rating, it will qualify as long as it is considered service-connected.

http://www.militarydisabilitymadeeasy.com/service-connected.html

To make sure you receive a fair rating, it is vital that your physicians record the extent of your condition as thoroughly as possible, including ECG tests of episodes. Supraventircular arrhythmia is rated on the number of episodes/year, but each episode must be documented by an ECG to qualify.

http://www.militarydisabilitymadeeasy.com/theheart.html#p

Ventricular arrhythmias are rated on a number of factors. Make sure that the medications used, MET test scores, imaging test results, ejection fraction scores, and all symptoms/episodes are thoroughly recorded in your medical records. This will ensure that the condition is properly rated when the time comes.

http://www.militarydisabilitymadeeasy.com/theheart.html#f

With the very limited knowledge I have of your condition, it probably would not receive a very high rating at this point. However, if it worsens in the future, the VA can increase your rating to reflect the severity of the condition.

I sent in my appeal back in 2013 had a hearing in Feb2016 took the hearing officer until Dec.2016 to get it to the rating office. have not heard one thing from the rating office and it has been a year now do you feel I should enter the RAMP program? My main question is if the hearing officer decided in my favor and is just waiting a rating to be assigned will the Ramp program, just take the hearing officers decision and assign the rating ? or will it get a whole new review? Please let me know Jtruscott171@gmail.com

Have you received an invite to use the RAMP process? If your case has already been decided, then it is unlikely that they will send you an invite. So if you receive an invite, then it won't hurt you to switch over unless you case is fairly complicated. If it isn't and clearly fits into one of the two fast lanes, then it might be best to switch. If it is more complicated, then just stay where you are.

What is my chances in getting high rating with COPD Gulf War or environment related to it. I have service records for SOB from deployment and till this day I still take meds such as albuterol, steroids albuterol, nebulizer and allergies shots and periodically doctors visits f/u. My last PFT was normal however it does says patient unable to exhale for 6 seconds on FVC he appeared to be short of breath albuterol was given. Mild air trapping was diagnosed. Thanks for the help.

COPD is rated on the Respiratory Rating System based on your test results. Since the records state that your PFTs were normal, then you would only qualify for a 0% rating. Your tests would have to be limited (not normal) in order to qualify for a rating for COPD. You can check out our rating chart under the Respiratory Rating System:

I have a cam and pincer impingement in both my left and right hips. This was not diagnosed while I was in the service but manifested itself with significant hip pain after PT and sitting for extended periods of time "Indian Style". Sitting in the position was required in boot camp and At times it was difficult for me to stand up and move when instructed too. I recently had to have surgery to repair my left labrum after a very minor fall to my knees. Speaking with the orthopedic doctor he indicated that my labrum had been beaten up over a very long period of time and that the fall was basically the straw that broke the camel's back so to speak. More than likely my right hip is in the same condition due to the same bone structure of my hip and femur.

I filed a claim but was denied. I read that a genetic issue could not be rated but if there is a condition that was aggravated by military service it could be rated. I was denied for a "hip strain" bi-lateral. Would there be a better way to file the appeal or would it be better to refile under a different claim? What would be the best approach to get this service connected?

My appeals is a an administration level that I was told by the 800 number is at extraschedular. I am applying for IU do to Reiner's syndrome, multiple joint issues. My question, is this a good thing for a positive outcome?

Since it's extraschedular, I'm assuming that it's difficult from the evidence you submitted to determine whether or not you really are entirely unable to work. They could definitely still decide in your favor, they just needed someone to take a deeper look at everything.

Thank for replying. I am receiving SSD due to my sc disabilities. I am 70% but none of them are 40%. The VA examiner stated my disabilities are preventing me from being gainfully employed. Could this be the reason for the extraschedular? Sorry it took so long.

That would definitely be a contributor. Without a single condition rated at 40%, you technically don't meet the requirements for IU. Maybe upon deeper review they'll find an exception, but it's likely you'll still be denied since you don't meet the requirements. Luckily, they are taking a deeper look since it seems you have significant evidence that says you are unemployable because of your conditions. Maybe that extra look will work in your favor.

Dr. George P. Johnson I denied for liver disease secondary for ptsd and migraines meds. I just found out that I have new evidence for HEP B and HEP C records while in service in which can overturn the previous to decision. What is the chances in winning my appeal since I was treated in service and having hemochromatosis diagnosed as well. Thank you.

If your current liver disease is connected to the hepatitis, then you have evidence that it existed while in service and you should be successful. Hemachromatosis can also cause liver disease, so depending on its service-connection and the details of your liver disease, it could also be the cause.

A letter from your physician stating that your liver condition is "more likely than not" caused by your hepatitis or hemochromatosis could also help your case.

I retired in 2005 after 21 years. I injured my Thoracic spine early in my career, it healed and I thought all was fine. On my retirement physical, the x-rays revealed 3 compression fractures in my thoracic spine. Over the past few years, I have had several for compression fractures in the Thoracic spine. I found out 2 years ago that I have osteoporosis and it runs in my family , 2 of my brothers have it also. I do have a 10% rating for my back but believe it should be higher since I literally cannot do any type of impact exercises or lift anything heavy for fear of more injuries. 9 of the 12 Vertebrae are compressed, I have been hesitant about trying to claim the Osteo, but my initial injury occurred in my 1st 4 years in the Army during a field exercise. Is there any any to claim the Osteo? Thank You Sir, John

There is definitely nothing against claiming osteoporosis, although if it is only manifesting in your spine, you are unlikely to get a second rating for it. The VA will only give a single rating per body part, so only one rating can be given for the cervical spine and a second for the lumbar.

Since the osteoporosis was diagnosed after service, however, you'll have be able to prove service-connection, most likely that it was caused by another service-connected condition, like your spine. If you can so service-connection, it definitely can't hurt to apply.

As for the 10%, that is probably the correct rating, unfortunately. Spine conditions are rated on limited motion, and the range of motion has to be pretty limited to get a rating higher than 10%. Take a look at your medical records, however, and compare your range of motion measurements to the Spine Rating chart to determine if your rating is correct. If not or if your range of motion has worsened since then, definitely submit to have your rating increased.

The VA rates knee conditions based on the main symptoms: usually limited motion an pain. If your knee does not have severe limited motion, then the minimum 10% rating is given for pain. The knee scopes are not evidence of a severe disability themselves and so do not contribute to rating consideration. Instead things like limited motion, pain, and instability are considered when rating. If your range of motion qualifies for a higher rating than 10% or if you have instability, cartilage dislocation, etc., that would qualify you for a higher rating, then you have a case for appeal. If not, then you were rated correctly.

You can't surpass the appeals process, unfortunately, so you just have to hang in there. The higher courts will not review your case without you having gone through the appropriate appeals procedures first.

Basically, you'll just stay in the line that goes directly to the BVA, which is the incredibly long one that is taking years to get through currently. The benefit of staying is if your case is more complicated and wouldn't be able to completed in one of the other RAMP lanes. This would mean it would still end up in the BVA line, but you'd lose your place. So if your case is more complicated and unable to be completed by the RAMP lanes, then it is more beneficial to just stay.

Hello! My husband was denied for bilateral inguinal hernias that were diagnosed 40 days after discharge from active duty service. The VA states the condition should have been caught at the return exam. Problem is - he is National Guard! They didn't do return exams at that time, the exam was scheduled with the VA. It's my understanding that now it is customary for this exam to happen on re-entry to the US, but it was NOT then. We have been waiting for BVA appeal since 2016. We are being offered RAMP, however, we're terrified it will push us back so much farther. What would you recommend? And how do you get the VA to understand the exam opportunities for national guard at that time (2013)

Tricky situation. Inguinal hernias is not on the list of chronic conditions that are automatically approved if diagnosed within a year of discharge, however, only a month after service should still be sufficient evidence that they were present while in service.

It's odd that the VA is noting their reason for denial as the fact that it was not noted on the exam. If the exam didn't even exist, which exam are they referring to? You shouldn't have to prove that the Guard didn't do an exam. If there is no record of the exam, then there was no exam, and so of course it wasn't noted on the exam.

Was there another exam conducted around the same time that the VA is actually referring to? If so, then clarifying what that exam was and why they didn't record the hernias is important.

Ultimately, this isn't a clear-cut case. As far as RAMP is concerned, it is likely that they'll end up sending your case to the BVA anyway, so it may be best to stay where you are. It's a tough call. It would be a risk to use RAMP, but if there is clearer evidence than I am aware of, it might be worth the risk. However, it could ultimately prolong the process. Tough call.

I am a Blue Water Navy Vietnam Veteran who was denied service connection for prostate cancer caused by exposure to Agent Orange. The current VA policy is that only those with "boots on the ground" qualify for presumptive exposure to Agent Orange. I have since found evidence that my ship tied up to a pier where Agent Orange barrels were leaking. Also, as a student naval aviator, I underwent survival training at Eglin AFB in Florida where Agent Orange testing took place. My intention is to present this as new evidence for my appeal. My question is, is it possible to know where I am in the appeals process at this time? I appealed in March, 2016. If accepting the invitation to the RAMP and selecting the lane that allows new evidence, how can I know if this will allow me to submit my new evidence sooner than I could if I stay in the legacy appeals process? Thank you for taking these questions about RAMP.

There isn't a way to know where you currently are in line. However, if you switch to RAMP it is likely that your case will get sent back to the BVA anyway. Blue Water Veterans are not currently on the Presumptive List, since that bill stalled in the House last year, so your case is not straightforward. In order to win this one, they would have to make an exception to the laws based on the quality of the evidence you have, and that would have to go through the BVA. You can always give it a shot, but it's probably best to stay where you are, at least until a bill is passed that puts you on the list officially.

Thank you for the reply. My new evidence, however, has nothing to do with being Blue Water Navy, but shows exposure to Agent Orange at two other locations. It would not be an exception to the law as I see it. Rather than presumptive, it would be more in line with direct exposure. I spoke with my Regional Office in Roanoke, Virginia yesterday and you are correct in that there is no way of determining where I am in the queue. I was told that I am at least a year out of being able to present new evidence to a Decision Review Officer. Opting into RAMP may allow me to present my new evidence sooner, but as the program is so new, there is not enough data upon which to rely to know how much sooner.

Yes, that's what the Regional Office told me: No guarantee. As the invitations from Roanoke had been sent out the first week of March, there was no way to know if opting in moves one up sooner or not. I'm thinking of giving it a shot as my appeal was going to be presented to the Decision Review Officer at Roanoke and not the BVA. One thing I did inquire about was if by opting into RAMP, does that just make those in the queue wait any longer? I didn't want to make those who have been waiting much longer than I have to have to wait even longer. I was told that there were probably many who would not opt to join RAMP and be content to simply wait. Many VSOs are posting that RAMP isn't a good thing, but like most things, it depends on one's individual circumstances. Thanks again, Dr. Johnson. I appreciate your taking questions and responding so quickly.

No, you jumping into RAMP won't affect anyone else. Those still in line will stay in line for the BVA. If RAMP ends up sending you back to the BVA, you'll end up at the end of the line, not the beginning. It's a different path, not cutting in line.

Thanks. From my understanding, I'm not in line for the BVA now anyway. I'm merely waiting to present my new evidence to the DRO in Roanoke. If that does not go my way, then I end up in line for the BVA.

Dr.I just received an invitation to participate in the Ramp program. I looked on line and found articles from different Lawyers who represent veterans, and they all basically say stay out of Ramp. There reasoning is sound, in one cause you cannot submit new evidence, and if denied you have to wait until Feb 2019 to appeal. Another reason was va has never been good at estimating how long it takes to do anything, yet they claim an average of 125 days and you will have an answer under ramp. And the third reason for remaining with he old system is because if you find you do not get your claim approved you cannot get back into the old appeal system. Finally, if you do go to ramp it is very possible that you will receive the same denial that you already received since the same people will be making the decision on your appeal. I don't trust the va to do anything correct. I've been dealing with the va since 1986 so, and I was a service officer for about 3 years, I understand the system, and I still don't trust the va to do anything right. Are you for or against the option to opt into Ramp, or do you thing as I do, that the sooner I opt in the sooner I become a VA guinea pig, because until the do ramp for a while they really have no idea if it will work better or be worse. thanks

Rick b, the third reason you cite is that once you are denied in RAMP, you cannot get back in the "old appeal system." Just what exactly is the old appeal system? If you see my circumstances above, my claim has not yet been looked at again as I have new evidence I want to present. If I fail at that, what is the new appeal system in Feb of 2019 and how does it compare to the old one? Thanks in advance.

The " old " appeals system is the system that is presently in effect, and will be changed over in Feb 2019, all new appeals after Feb 2019 will be under the new Ramp system. The only reason some of us are receiving an invitation to use Ramp now is because the VA needs guinea pigs because they have no idea how it will work when it actually goes into effect in Feb. The say it will take 129 days to finish an appeal under the new system, how in the world do that know that, when few if any claims have been processed under ramp.

Thanks, Rick b. That's what I understood as well. From what my VA rep at my RO told me, I'm not likely to be able to present my new evidence before Feb 2019 as it is, so maybe opting in just gets me before the Decision Review Officer sooner than Feb 2019. The only thing that would make decisions faster is if someone decides them faster because they're under a deadline. From what I have heard, there are no repercussions for missing deadlines anyway. Also, it's easy to deny claims and put them in the appeal lane, the result of which gets them off someone's desk and helps them clear out their inbox. Bingo! Deadline met...bonus secured! I'm on the fence but may opt in to be a guinea pig. If HR 299 gets funded and passed, nothing I do now will matter anyway.

Rick, you bring up some good points. The reality is this system is untested and so we don't know just how it will go.

However, for simple cases that are straightforward, it should be effective. These are cases with clear errors made by the VA (not ones that you'll have to fight), or that just needed new evidence.

Now you mentioned that they don't take new evidence. Actually, they have an entire lane for cases with new evidence to consider. So if your case has new evidence that will clearly change their decision, then this could definitely be the way to go.

As for the timeline they are giving, yes, their wait times for appeals is atrocious, but you have to give them credit for the changes they made to the initial claims system a few years ago. They have fixed their wait time for original claims. Most are now determined in the time frame given. And that is the goal of RAMP--to fix the wait times. So they should have it done in the promised time. Hopefully.

Yes, if you jump ship, you can't go back. But in the current system, you may wait until Feb 2019 (or longer) anyway.

It's really just a risk. For simple, straightforward cases, it's probably worth it. For others, maybe not, especially if your appeal has been pending in the system for multiple years already.

Veterans will be able to appeal to another lane if they disagree with their initial RAMP decision. If you receive an unfavorable decision within the RAMP system, you will have a one year appeal period to take your case to another RAMP lane (the Supplemental Claim Lane, the Higher-Level Review Lane, or the Board/NOD Lane), and your effective date will be protected.

The Board of Veterans’ Appeals (BVA, or the Board) will begin deciding RAMP appeals in October 2018. Previously, VA planned to open only the Supplemental Claim Lane and the Higher-Level Review Lane to RAMP participants, leaving any appeals to the Board until VAIMA (the new appeals system) was fully implemented in February 2019. But at a March 2018 conference for veterans’ advocates, Chairman of the Board Cheryl Mason announced that the Board will open to RAMP participants in October of this year.

The new appeals system calls for three dockets at the Board, separate from the legacy appeals docket currently in operation. Veterans who appeal a RAMP decision will be first in line in the Board’s new dockets.

Greetings Dr,I opted-in on March 6th, all new evidence were added before Feb 15th and I called to confirm it has been posted. My condition is Pes Planus with Plantar Fasciitis/callous/spurs. I selected Higher-Level Review with Informal Conference. Lets see what happens. I dropped my NOD on Dec 7th 2017. So I have nothing to lose. Let the 125 day countdown begin, I'm on day 5.

I received a RAMP letter. I have had 5 back surgeries, a nuerostimulator, and right hip replacement. All paid for by the VA. I submitted my appeal back in June. Since that time I’ve had to have a new neurostimulator put in, left hip replacement, and many injections in my back. Due to the amount of surgeries I’ve had I developed CAS catastrophic a antiphospholipid syndrome and now have to get bi weekly infusions. So I do have new evidence to submit. I’m currently at 70% fighting for 100%. My biggest question is do you still get back pay through RAMP? I feel a lot of the article written online are by attorneys which they seem to be against. My guess is the new program is cutting them out in some way. Do you think it’s a Roth it for me to try?

Since you just submitted in June, it probably won't make your situation worse to try RAMP. The current wait time is years, so at only a few months in, it probably is worth the risk to give it a try. We don't really know at this point.

However, new and secondary conditions aren't added to your disability through appealing. You need to submit brand new claims for the new conditions, even if they are secondary to your currently service-connected conditions. So since CAS is a new diagnosis, just submit a new claim for that as secondary to your service-connected surgeries.

My claim has been on appeal since 2013...waiting for a DRO...had very favorable C&P exam 4months ago and decided to opt into ramp Feb.21...my logic is that I've submitted all information from my personal doctor so why not opt in and choose Higher Level Review, just recently having a favorable C&P should make it easy for them to rate me correctly this time around....i hope! We shall see

Ebenefits shows my claim complete as of March 16....i call the 800# and they informed me that is it's not necessarily complete but that it's officially into Ramp and claim will be complete not later than Aug.16 .....

I am wondering if the 800# gave a generic completion date (125 days) or if the date is actual to your appeal. I have been searching to find out a link to check RAMP status but am unable to locate. I truly wish the VA would of made RAMP more veteran customer service oriented instead of calling 800#

Any dates they give you are going to be generic and an overestimate of the actual time they'll take. They do this so that you are prepared to wait longer, but then happy when it comes back before that date.

I'm wondering the same thing, Corey. I visited my local DAV chapter yesterday and they emailed my application for RAMP along with my new evidence. I'll be checking periodically to see if the status shows up in eBenefits. I imagine it will show the same as regular claim status, i.e., received, in process, being reviewed, etc. If I see something, I'll post it here.

I was able to see on vets.gov (not eBenefits) that my RAMP claim had moved into the "evidence gathering" phase on July 5, 2018. On July 12, 2018 I received a phone call from a VARO rep in Waco, TX. He asked a few questions about my claim and then sent it on to Washington that afternoon. From his tone, I think he has recommended that I receive service connection for my prostate cancer. I think that the VA in Washington, D.C. takes his recommendation and then begins the process of assigning the rating, etc., and then sends out the notification letter. I'm not really sure how the procedure works, but I think that a regional office (RO) makes the decision and forwards it to DC and the VA in DC sends out the official notifications. Perhaps Dr. Johnson can weigh in on that. Oh, as a reminder, my official opt in date for RAMP is March 27,2018.

Beginning on April 1, 2018, VA will allow any veteran with a pending appeal to opt into its Rapid Appeals Modernization Program (RAMP). This is a major pivot from VA’s original enrollment strategy, in which veterans had to receive a RAMP invitation letter before opting into the pilot program.

The Rapid Appeals Modernization Program (RAMP) is a pilot program designed by the Department of Veterans Affairs (VA) to test the new appeals system scheduled to launch in February 2019. Signed into law in August, the Veterans Appeals Improvement and Modernization Act (VAIMA) of 2017 required the creation of a new appeals process that would allow veterans to choose one of three appeal “lanes.” VA refers to the pre-VAIMA appeals process as the Legacy Appeals system.

As of March 1, 2018, the number of veterans who chose to opt into RAMP since its start in November 2017 was lower than VA expected, with only 2,462 veterans opting in out of the 84,546 veterans invited. That’s about a 3 percent opt-in rate, which falls well below VA’s projected 10 percent rate.

In a presentation last week, however, VA indicated it will be quietly abandoning the invitation-only plan for RAMP. At the Waco, Texas VA Regional Office, officials said that, starting April 1, 2018, any veteran with a currently pending appeal will be able to opt into RAMP by using a publicly available RAMP Opt-in Election form and bar code cover sheet.

Dr. So I received a letter from VA with most of the claims denied. Will I have the opportunity to do the ramp, or just stay in the old system. I did receive my decision fairly quickly ( less than 4 months). Also is my discharge physical a good enough nexus for the VA? I am still going to the Seattle VA hospital for the same problems yet they said in the letter I need "new & material evidence". Honestly I'm at a loss here because I'm not sure what else they need. All my records are at the VA hospital they have access to them.

How to appeal and what evidence they need depends on exactly why they denied the conditions.

Did they say they were not service-connected? If so, then you need to show evidence of them having been originally diagnosed and treated while in service. If you do not have this evidence in your military medical records, then you'll need evidence that supports one of the other requirements of service-connection or supports that you qualify via the Presumptive List.

http://www.militarydisabilitymadeeasy.com/service-connected.html

http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html

Them asking for new and material evidence means that whatever you submitted did not show enough proof that your conditions were service-connected. Once you figure out how your conditions qualify for service-connection, then you need to provide as much evidence as possible that supports it.

As for RAMP, you'll receive an invitation if you can apply, but go ahead and apply via the old system first. Then you'll be invited to switch over.

I also received an invite I am at the DRO level since last Sept for Sleep Apnea secondary to Tinnitus and Rhinitis I have submitted and I M O from a doctor which makes the nexus on both issues I also show on c-file in military with many trips to sick bay for many E N T issues as well as epitaxies including where the doctor states on my exit medical check states E N T issues with epitaxies I also have been diagnosed with deviated septum if I choose the ramp program which lane would I choose and do I have to submit the entire N O D over again??

If you have new evidence that you did not submit with your original claim, then you need to pick the New Evidence lane. If you submitted everything you noted above with your original claim, then you do not have new evidence and need to pick the local higher level review.

You don't need to submit the NOD, but follow directions on the invitation. They'll tell you exactly what you need to submit to them.

My question is my file is now at my regional office at the DRO level since June 2017 Sleep Apnea and MTSP, which is a appeal in which they said it could take about 394 days. Now my question is it best that I wait or try to do the ramp. Don't know much about this process.

That's the big question, Andrea Blair. No one, posting on this board at least, has gone all the way through the new process yet. I had new and material evidence for my claim, so I figured I'd jump in and submit it now rather than waiting to see my DRO at the Roanoke, Virginia, Regional Office. I haven't found out yet if my RAMP claim will be sent to my regional RO or if it will be seen somewhere else. I guess it doesn't really matter at this point, but like others have said, I wish there was a way to monitor the progress as it goes along. I'll know when I know, and I'll post here when I get word. My official opt-in date is 31 March 2018, so I still have a way to go yet.

Yes, we don't really know how long things will take and how this program will really end up working. However, if your appeal time was really quoted at 394 days, that will have your appeal finished this August. There is no evidence that RAMP will have it finished sooner than that, so it's probably best to not switch over, but just wait it out. Many appeals take YEARS, so RAMP is a great option for those, but if the 394 day estimate for you is really accurate, then switching to RAMP could be a risk.

Yes, that's what I figured. Like you, I figured the MSRA was a typo. My admonition still applies in my opinion. While you are an MD and most likely know all of the acronyms, most of us don't,so rather than making the rest of us look them up, it would be helpful if posters would spell them out when they use them initially.

I just received an invitation and opted for higher level review as the only new information is located in my medical records. I am currently at 70% and was forced to resign from state corrections due to their refusal to provide accommodations. I have severe nerve damage in both feet, my right being worse. I asked to use cam boot and asked that on days with severe pain, that I be allowed to leave without being penalized. I was denied and did file and EEOC complaint, but unfortunately the EEOC stated that the prison was short staffed and could not afford to have an employee leave. I have had a heck of a time trying to find new employment with accommodations. I filed for IU, which is in appeal. Oh, and I used my husband's profile, my name is Rebecca Glorioso. Is there anyone who has had an appeal decision from RAMP yet? Just wondering if it was worth opting for. Thank you.

An appeal for Individual Unemployability is not the "standard" appeal that RAMP is directly targeted for. Because of this, I would be hesitant to suggest that you opt in. RAMP is for straightforward appeals to basic disability, not specialized benefits like Unemployability.

Tough call, though. If your case is really strong and the VA made a definite error, then maybe it is worth it. However, for things like Unemployability, the strength of a case is hard to determine. Based on the little information I have, I feel like it is a judgement call by the VA, so not a clearly strong case, but one that could go either way.

Rebecca, so far no one posting on this page has had a decision as far as I know. I think I read somewhere that some have been decided in as little as 33 days, but they could have been very simple claims. My claim is in the Supplemental Lane, which may or may not be quicker than the Higher Review Lane. Every claim is unique. Good luck with yours.

Recieved two service connected ratings of 0% for depression and siezures secondary to neuro sarcoidosis.The statement of claim stated no compensatory symptoms .clearly incorrect ratings for each.VA guidelines read that just being diagnosed requires a minimum 10% rating for each.I requested a reconsideration and got the same results.I recieved the RAMP invite my question is should I enter the program and take a third bite of the apple with the same reviewers or continue in the current appeals process.just looking for opinions.By the way in my case the VA moved pretty quickly the initial claim 6mo the recosideration 3mo.

If you do not have any new evidence, I would not opt in to RAMP. You need a higher level of review by the BVA. Going through the same people won't make a difference.

As for your claim, I just wanted to point out that there is not a minimum 10% for diagnosed depression. The minimum for that is 0%.

http://www.militarydisabilitymadeeasy.com/mentaldisorders.html#system

You are correct, however, that an official diagnosis of epilepsy with a history of seizures is rated 10% minimum. To diagnose epilepsy for rating purposes, however, a seizure must be witnessed by a physician and neurological testing performed during the seizure. As long as you have evidence of this in your medical records, then you do qualify for the 10%.

Hello, I was diagnosed with ED while on active duty. Received a 0 percent rating from VA for this condition with no SMC K for loss of power of a reproductive organ. Is this considered a CUE? How can I apply for the SMC K? Thanks.

Doc. I was diagnosed with glaucoma while on active duty it was over looked on my original C&P exam. It has since gotten worse I submitted a claim and it was denied saying it wasn’t service connected. I filed an NOD along with the evidence that I was diagnosed with it while on active duty. I was then given a C&P exam for that. It’s been since 2015. I recently received an invite to the RAMP process and choose the higher authority option. Even though it says no new evidence can be submitted, will they still look at the evidence & C&P exam that was submitted 3 years ago. Or will it just be what they based it on the first time. If not how do I go about changing it to a different option?

Since the new evidence is key to the success of your claim, my instinct is that you need to be in the New Evidence lane, not higher level review. The new evidence wasn't considered in the original decision, so it is still considered new evidence (although submitted 3 years ago) until it is officially reviewed.

Since this is a new system that is untested, I'm not sure the best way to choose the new evidence option if they aren't giving you the choice. You may need to contact them directly if they don't give you the choice during the application process.

I received my 2nd invitation from the Baltimore VA. I am currently rated at 100%. I disputed the dates that my compensation went from 40% to 60%. I was medically retired at 40% from US Army in 1990. My initial filing for my conditions getting worse was August 2009. I was increased to 60% effective in March 2010 after my VA Exam. Eventually I was increased to 100% in October 2010.

I informed the VA and provided medical evidence of me receiving treatment from a civilian provider since 2008. My question is: when this new claims official gets into my file, will he/she look at what my dispute is (effective date for increase from 40 to 60%), or will they be going over the whole ball of wax? What I am asking is: am I putting my 100% rating at risk of being changed when the new eyes look at it?

Again, I am disputing the starting date of my compensation increase frm 40 to 60%. I felt it should have been when I first filed for a new review in August 2009, not March 2010 after my visit with VA doctor. Thanks in advance for you comments and advice.

I opted into RAMP, effective 31 March 2018. Periodically I check vets.gov to check the status of my appeal. So far, it says that a status is not available for those in RAMP. However, a few days ago, the following was on the page: "On March 01, 2018, VA sent you a letter to let you know about a new program called the Rapid Appeals Modernization Program (RAMP). However, this appeal isn’t eligible for RAMP because it is active at the Board of Veterans’ Appeals. If you have other appeals, they may be eligible for RAMP." I called the number listed for the BVA and the lady said that I was not active at the BVA and she showed that I was in RAMP, which is still at the Decision Review Officer (DRO) level. She said that another veteran had called with the same issue. Apparently there is a glitch with what is being put on the page. Has anyone else in RAMP seen the same notice?

Thanks MS and Debsus. This morning mine still had the same box saying my appeal wasn't eligible for RAMP. I did speak to someone at the VA and they said that I was still indeed in RAMP, so it must be a glitch, which isn't that surprising with so many veterans and different databases. I did read somewhere else that so far those in RAMP had their decisions around the 37-day mark and that 61% had their claims approved. The normal rate of approval is 25% it said. Keeping my fingers crossed as my 37 days are up next week.

I had a undiagnosed AVM in the military. He of chronic migraines and a pop on left side of my head that caused me to pass out. They missed it on my MRI. So I was denied compensation and I had a statement from head of nuerosurgery starting it was as likely as not it was there. According to regulation of it is as likely as not there are to rate in favor of veteran. Now I have a Ramp letter. Previously and waiting review based on my notice of disagreement. Should I opt in the ramp program

Did you submit the neurosurgeon's statement with your original claim? If so, then RAMP may not be as easy as hoped. If it is new evidence that hasn't been seen yet, definitely submit it to the New Evidence lane of RAMP.

While they are supposed to decide in favor of the veteran, they still have to have fairly irrefutable evidence. While nexus letters are definitely helpful, they are not always irrefutable, especially if you only have a single letter and there isn't any solid evidence to support it otherwise. Depending on the quality of other evidence you have, yours may be a more difficult case that needs a higher review anyway.

That being said, if the letter is new evidence, it is worth a shot to give RAMP a try.

I am trying to get service connection for menieres disease. How likely is it that I can do so? I have seen a doctor for vertigo issues while I was in as well as have an Otolaryngology specialist connect it via letter from diving and TBI while I was in. Is this something that could be truly connected with this evidence? I am having vertigo spells about twice a week right now and losing hearing progressively. Also shows hearing loss from start of service till discharge from military. Thank you

Sounds like you have fairly strong evidence. It's impossible to say definitively without having reviewed your entire case, but you definitely have a strong chance. Since you have service-connected evidence of hearing loss and vertigo in service that will help. And your nexus letter connecting it to the TBI while in will help as long as your TBI is also considered service-connected. Seems like you've put together a fairly strong case, so hopefully it will go in your favor.

I applied for PTSD August 2015. I was denied because the initial C&P exam was not finished and they denied for me for a reason that I NEVER claimed. I was denied because Bi-polar is not from the military??? I was to be evaluated for PTSD and was diagnosed in the initial exam. I filed my appeal and did a new C&P exam and the new eval clearly showed 15 errors made and I should hae been awarded PTSD and be service connected. I was sent a RAMP offer and i joined. My claim now says "Claim closed?" Will the Higher Review officer look at the new C&P exam? I submitted my RAMP papers 5-17-2018 and the Re Evaluation was conducted in April 2018. Will I get back pay from 8-2015? It says no new evidence but I pray they look at the mistakes made in the initial eval and the new evaluation. Thanks

Hi Rich - Sorry for the delayed reply. Google got a bug, and we weren't notified of your post.

It is very odd that they would deny you for a condition that wasn't listed on your original exam, so it definitely seems that they made an error that should be easily corrected in RAMP.

When they reviewed your case, they should have looked at all evidence that you submitted with your appeal. Since you submitted the appeal before the new C&P exam in April, then that will not be considered with the claim unless you submitted it as new evidence. You would need to submit it under the New Evidence lane in RAMP in order for it to be considered.

If you did, then you should be on the right track. Hopefully they'll review everything and get it done correctly for you.

If they do decide in your favor that the VA made a definite error in their original decision, then yes, you should qualify for back pay to the date of your original claim submission.

Hello Dr. Johnson; my question is twofold. I had an evaluation the other day done by the VA’s new evaluation contracting group called; VES (Veterans Evaluation Services). This evaluation was for an ongoing appeal for a claim I put in back in 2013. The person doing the exam was very new to the exam field and only started working in this field back in December 2017. Here are my questions; 1) if the examiners write-up shows too favorable towards me, do you think the VA will not accept the examiners write-up/findings and request that I go see another examiner? Secondly, I was sent an invitation to have my appealed case heard in RAMP, but I haven’t yet accepted that invitation. So will this hurt my appeal status, negatively, in the VA’s eyes?

Hi Boris - Sorry for the delayed reply. Google got a bug, and we weren't notified of your post.

1. Absolutely not. The exam is just data, and the VA can't decide if data is "too good." It is what it is. The VA will look at all of your data, favorable or not, and rate you based on the evidence of your condition.

2. And no, you do not have to choose RAMP. It is completely optional. And the timing is up to you. The people ultimately doing the ratings will probably not even be aware of your choices/timing. Even if they did, it wouldn't factor into their decisions. As long as you meet required deadlines, the rest doesn't matter to them.

Dr. Johnson, My case is fairly complex so I will just break it down to the basic facts. I had a radiation exposure while on a sensitive assignment (documented, not dosimeter). I was diagnosed with Hairy Cell Leukemia (HCL) and received Chemotherapy (VA) in 2009.Since the incidence of Hairy Cell Leukemia is three out of a million, I felt that the exposure caused the HCL. I have submitted proof of the exposure, proof of my presence and radiation levels, as well as a strong supporting letter from a VA Hematologist. The claim was denied twice stating I did not file within prescribed time limits and that here was no record of any in-service treatment. VA's own regulations state there is no time limit for leukemia to manifest and I was retired from active duty before it did manifest. Certainly if there is no time limit on claiming Leukemia, the reasons for denial of the claim of not filing with in the time limit and no record of in-service treatment are invalid. My local Veteran Service Office doesn't understand why the denials and told me that claims with much less supporting evidence have been approved. I have been advised that VA is simply running a check list and is not actually reviewing the claim. I Filed a Notice of Disagreement a month ago and submitted a RAMP request two days ago. Several people with experience in processing this type of claim advised me to get a lawyer and request a hearing and that the hearing board would most likely approve the claim very quickly.I think that my frustration is that its apparent that the evidence submitted is not being reviewed or taken into account. I have high hopes that RAMP will if not approve, at lease give some valid reason(s) for not doing so.

Yes, a definite mistake was made. There aren't any time limits on leukemia after radiation exposure, and it sounds like you have all the necessary evidence to prove exposure.

I think your case is too straight forward to spend money on a lawyer yet. RAMP should fix this. It is fairly simple and should be an easy fix on their part. They do review evidence, so you should have a favorable outcome.

Doctor Johnson, To summarize my issue. I filed a RAMP Opt-In on 22 May 2018. No status or update has been posted on EBENEFITS or Vets.gov since filing.I called the VA 800 number several times and was told that they had the Opt-In. I notice that every other RAMP Opt-in was getting posted on EBENEFITS within two weeks. After 72 days with no update and seemingly the only Veteran that didn't have any kind of status posted, I call the VA 800 number again to try and get some type of status. I did! My RAMP Opt-In had not been processed, there was no reason known as to why it hadn't been posted. The person I was speaking to was very courteous and seemed very knowledgeable. He pulled up my Claim and his exact comment was "GOD" what a mess", he said that nothing had been done since 2 July, that I wasn't in RAMP and that he couldn't tell what had been done or who had worked on the file, further that the claim notes didn't make sense. He said he was embarrassed that my claim had been handled so incompetently and after a 40 minute conversation in which he still couldn't find out what was going on, he said that he would get to the bottom of the situation and get it back into the system. Since my RAMP-Opt-In hasn't been processed yet I'm guessing that the 125 day clock hasn't started. If I don't get some answers by next Week I'm going to file a Congressional. My thoughts are that since an initial mistake was made in denying my claim and it would most likely exceed the 125 day goal, that it got ratholed/buried or placed in the lie until they die file.

I am definitely seeking advice? If I hit a dead end with this, is their anyone in the VA system that I can contact for help. I know that there is a White House hotline and during my career have worked on several congressional investigations. I'm very frustrated and while a few people have advised me to be patient because the RAMP Opt-In was only received by the VA on 22 May. This has been going on since 2009. The claim is fairly complex and has some security issues involved. I can't help but think it was sidelined deliberately.

It sounds like the person you got on the phone was trying to do his job right and help out, so that's at least a good sign amidst this mess. Let's hope that he is able to figure out what is going on and get this fixed.

The VA doesn't punish people for making a mistake (maybe unfortunately). But that means that there really isn't a logical reason for them to choose to bury it when going to RAMP. They would get in more trouble via the supervisor for a lost or buried case than just having a late one.

This is definitely a mess, though, and an inexcusable one. They had no reason not to process the appeal properly the first time. I'm really hoping this last guy you spoke to will be able to correct things and get things moving for you. Did you get his direct number? I'd follow up with him in a few days since he was so responsive.

If you still get the run around in a few weeks and no progress is made, you can try to reach out the head of your Regional VA. Congress reps are also an option. I hope you are keeping records of all your interactions as those could help.

Doctor Johnson, Its day 131 an still no status or contact on my RAMP Opt-In. My VSO called me last Thursday and told me that she had just called the VA and they were as confused as she was as to why nothing had been done. As far as I know the 22 May Opt In has never been processed. My VSO has called and been assured that all is well three times. I have called VA and been assured everything was in order about six times. Most of these follow up resulted in my VSO and I being told that status would be posted on line and that I would get a call within a week. My VSO said it was the first time in about five years that she was unable to find anything out and that she didn't know what to do next. Anyway I finally had enough and called the White House hot line, registered my complaint and got assigned a case number. VA supposedly has 21 days to answer the complaint. Started to make it a congressional, but this may bring results. All I'm trying to find out is what stage of processing my appeal is in? Just updating my situation and venting a little.

I agree with your evaluation of what happens at the VA, FLCoyote. Yours seems to be a case of a clear error on the part of someone at the VA. Too often it seems as if in order to clear a full inbox, an examiner will deny a claim and get an "attaboy" from the supervisor for decreasing the backlog. What happens to the dolt who denied you in the first place? My guess is absolutely nothing. There is no accountability at the VA apparently. If a person denied and claim that was clearly valid and got in a heap of trouble, then claims might get the attention to detail that they deserve. This is most likely a reason for the huge backlog of appeals.

ok can anyone please answer me this ? i put in a claim for pseudofolliculitic in 2002 i was denied because they assume i had it before i enter active duty which is not true and that i enter 7-17-79 and was seen in the clinic 7-25-79 basically they say it wasnt enough time for me to bump up or manifestation. ok am i to believe that we all have the same skin help please.

Unfortunately, your evidence is fairly weak as far as the VA regulations are concerned. In their view, it is "less likely than not" that the condition was directly caused by your 8 days of military service. This condition is known to be directly caused by shaving, and that is not a practice that is solely military.

Now maybe you only shaved because you had to for the military and never shaved a day before then, but I can see why they determined it not service-connected. If you can show that you only shaved for the military, then maybe you'd have a case. But it would still be somewhat weak. Unless there is a definite event (training accident, etc.) that causes a condition, there needs to be enough time in the military before a condition is connected. 8 days is pretty short, so it's a tough call.

Dr. Johnson, my husband was a marine in the 70’s stationed at Camp LeJeune for over 3 years. He was diagnosed with Polycythemia Vera in 2012 and sees a specialist at MD Anderson Hospital in Houston. He is treated at the Leukemia Center, this blood cancer is in the leukemia family. There are 5 different blood cancer families they specialize in and 4 of those were automatically entered into the Camp LeJeune conditions for disability in March of 2017. Naturally his group is more rare and he was automatically turned down the first time. We received the RAMP invite this week, we submitted personalized medical information and reference information connecting benzene and other chemicals to this condition. I believe it was not even looked at, because he was not on the official “8” automatic conditions. Do you believe the Camp LeJeune cases such as this will benefit from RAMP or will be have to go to the Board in the Feb 2019 wait group?

It will probably have to wait to go to the Board, but I could be wrong. RAMP is only good for straightforward cases, and those would be the ones on the list.

Polycythemia vera is not officially on the list as it is not leukemia, but has the potential to become leukemia in rare cases. Because of this, in order to make a favorable decision, the case would have to be reviewed by a higher authority that has the ability to make exceptions. The lower authorities have to abide by the letter of the law as much as possible. Only higher authorities can look deeper and make bigger judgment calls like this.

Dr. Johnson I have a claim that says "Authorization Review Claim." This is a follow up to another question I posted in Jan. 18. I have an appeal pending since 2002 and I received a letter to verify my dependents in May of this year. When I check ebennies or Vet.gov it says decision has been made and wait for a letter but 800 and my VSO says it just a response to my dependents letter.I was told I was at administrative review before I elected ramp. Can you tell me what's possibly going on? Thanks in advance.

I'm unsure from your comment if you did officially opt into RAMP or not. If you did elect RAMP, then it's hard to say. They are still working kinks out of the RAMP notifications system, and we've seen some veterans have odd things being said in the system, but ultimately their claim wasn't affected.

Otherwise, I'd say it's still being reviewed and all you can do is wait, unfortunately.

Hi. I am new to this site but I see a lot of interesting information. I applied in 2008 and was granted 10% for radicular symptoms of the bilateral feet. Fast forward to June 2018 I am 100 percent and just got awarded smc RT2 which is the highest SMC from a DRO appeal. Needed that but while the DRO was doing the appeal he found a cue from the 2008 decision about my feet. I didn’t understand and he opened up a claim. I went into ebenefits and it says “Bilateral Lower Extremity Radiculopathy (New) from 2008”. I called the va 1800 and they said they couldn’t tell me much but one of them let me skip saying that she thought that it might of been because I should of been rated differently because when I injured my left foot my right foot had to overcompensate. I was wondering what you opinion was and why couldn’t the DRO officer just fix the cue if he found it or he couldn’t if it was going to get rid of one of my disabilities ? He did approve my appeal. Please your opinion

If I understand the situation correctly, then radiculopathy was not originally on your claim, but you were diagnosed with it. Radiculopathy can be rated separately from other conditions, so it sounds like the DRO started a new claim so that the radiculopathy can also be rated.

All conditions must be applied for (included on the claim) in order to be rated. DROs can't just add conditions. That's why it is important to include all of your diagnoses on the claims to make sure that all of your conditions that are eligible are rated.

If I'm interpreting what you said correctly, then you are actually pretty lucky. Most DROs won't go above and beyond like this, but will just ignore any conditions they see that are not included on the claim.

So case closed. Didn’t get my brown envelope but checked ebenefits and checked on disabilities and they added another disability from 2007 for radiculapath of my right foot at 10%. I didn’t get my 100 percent title til 2013 so would they be giving me a retro from 2007 to 2013 of the additional percentage that they added on? I know it’s not a lot but I know anything matters and for all those years could add up or because they initiated the CuE then I won’t? I would think that since from 2007 -2013 I was rated at 40%. Then they just added in this approval for cue for 10% of bilateral radiculaphy of right foot that I should get retro for the difference 6 years?

You will probably not qualify for back pay. The VA will only pay back pay to the date you submitted the claim unless they made a definite error. Since the claim for this was just submitted now, it's very unlikely that they'll give back pay.

Hi. Thanks for replying. I ended up getting backpay. Just got it today. I never put in the claim. The DRO officer put in the CUE when he did my appeal and granted my appeal for SMC rt2 and he saw a CUe from 2008 and then he submitted it back to Reginal and they approved it from 2007-2013 when I became 100 percent so I got the 10 percent of bilateral added for those 6 years because the DRO officer initiated it and they found in favor of me. Very rare to find in favor of me and I didn’t have to submit anything and very rare for a DRO officer to go beyond his duties to submit something for a veteran but I am grateful.

I am new to this site, but the information you are providing is extremely informative and thank you in advance for helping everyone out. I got out of the military in March of 2015 and didn't apply for disability until June 2017. I was trying to get a job in my old MOS as a flight engineer for helicopters(CSAR). I didn't want to my application to show I was broken. I was unable to secure a job in that market. I was denied all my physical ailments. I was diagnosed with Iliotibial Band Friction Syndrome (denied knee pain), diagnosed Temporomandibular Joint Pain (denied), diagnosed hydrocele (denied), diagnosed carpal tunnel syndrome and given surgery (denied), and sleep apnea (which I was just diagnosed for and will include diagnoses with appeal). If I was diagnosed by the military as having something, how can they deny that I have that issue now?

Do you have medical records with these diagnoses from your time in the service? Were you active duty or Reserves?

If you were active duty and have medical records showing proof of these conditions in service, then they should have granted the claim.

Did you apply for exactly what was diagnosed in service? For example, was carpal tunnel syndrome officially diagnosed while in the military, and if so, did you list it exactly like that on your claim? Or did you just have wrist/hand pain in service but carpal tunnel wasn't officially diagnosed until more than year after, but you still applied for carpal tunnel?

The conditions on the claim should reflect exactly the condition in service in order for the VA to be unable to deny service-connection. If you are claiming conditions diagnosed after service, they have a stronger case to deny you.

I was active duty during that time. I however was not diagnosed with Sleep Apnea until two week ago. The active problems on my medical record read as follows:Iliotibial Band Friction Syndrome on 26 Jan 2009TMJ pain on 18 Dec 2012Hydrocele of Male Genital Organs on 21 May 2013Carpel Tunnel Syndrome on 05 Aug 2013Patellofemoral Syndrome on 10 Oct 2013I applied for:Left Leg PainRight Leg PainTemporomandibular Joint Pain (TMJ)HydroceleCarpal Tunnel Syndrome, Upper Left Extremity (claimed as left wrist carpal tunnel)Carpal Tunnel Syndrome, Upper Right Extremity (claimed as right wrist carpal tunnel)Sleep Apnea ( which I didn't have documented at the time)

Sorry for not having gotten back to you sooner. I had to wait to receive another copy of the VA's last finds. The first document I received on Aug 21st had several conditions deferred. The following conditions were deferred:-Hydrocele-Carpal Tunnel Syndrome, right upper extremity (claimed as right wrist carpal tunnel)-Strain, right knee (claimed as pain)-Carpal Tunnel Syndrome, left upper extremity (claimed as left carpal tunnel)-Strain with trapezius muscle strain, right shoulder (also claimed as limited range of motion)-Strain with iliotibial band syndrome, left knee (claimed as pain)-Strain, left shoulder (also claimed as limited range of motion)-Bilateral pes planus (flat foot) (claimed as bilateral foot pain)

The letter I received on Oct 19th (copy just sent to me Saturday)stated the following for all of the above conditions:-Service connection for "name of condition" is denied.

No further explanation is given. The other conditions were rated on in my first letter Aug 21st and state the following:

-Temporomandibular joint dislocation (TMJ): The evidence does not show a current diagnosed disability. While your service treatment records reflect complaints, treatment, or a diagnosis similar to that claimed, the medical evidence supports the conclusion that a persistent disability was not present in service. We received your medical evidence which does not discuss symptoms of this medical condition. The evidence also does not show that any arthritis developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection.

-Sleep apnea: The evidence does not show a current diagnosed disability. Although your service treatment records show that you were prescribed medication for sleep, this was due to insomnia type symptoms. Your service treatment records do not contain complaints, treatment, or diagnosis related to sleep apnea. We received your medical evidence which does not discuss symptoms of this medical condition. Please note that a diagnosis of sleep apnea must be confirmed by a sleep study.

-Right leg pain: The evidence does not show a current diagnosed disability. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. We received your medical evidence which does not discuss symptoms of this medical condition. The evidence also does not show that any arthritis or nerve disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. Pain in and of itself is not considered to be a disability under the law for which compensation can be made without objective medical evidence of an underlying disease process.

-Left leg pain: The evidence does not show a current diagnosed disability. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. We received your medical evidence which does not discuss symptoms of this medical condition. The evidence also does not show that any arthritis or nerve disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. Pain in and of itself is not considered to be a disability under the law for which compensation can be made without objective medical evidence of an underlying disease process.

Was the first list of conditions deferred or denied? Deferred usually means that they are still trying to get enough evidence to support these conditions. If you have more evidence to show that these existed in service or can submit statements from your docs stating that they were caused by service-connected conditions, this could help for those.

Remember, to prove service-connection, you have to show undeniable proof that the condition existed in service. This can't just be a single visit to the doctor for foot pain and then you're claiming flat foot. The medical records have to show that flat foot caused recurring and regular pain during service and became a chronic condition in service (many people with flat foot have no symptoms at all).

This is why it is important to claim what can be clearly proven by your medical records.

You also must still have a condition in order for it to be considered a disability. Very few conditions recur after a significant break (though some do), so continuity is important for it to be clearly caused by your military service.

Looking at the evidence you have, is there a way to submit additional evidence or show further proof that your conditions existed in service? Can you claim the conditions differently so that the claimed condition is more fully supported by your military medical record? If not, you may just not have enough evidence to successfully claim some of these conditions.

The first list of conditions was originally deferred (8-21-17), they were later denied for not being service connected (10-19-17)

The TMJ was only diagnosed once. I was given a mouth guard to sleep with and was told that was all that could be done. I didn't bring it up again to medical, because I was already doing all that could be done.

I brought up my poor sleep (gets less than 5 hours of sleep on three or more consecutive nights) two years apart while in the military. I was just diagnosed with severe Sleep Apnea (43 episodes per hour)and issued a CPAP machine.

I was diagnosed with Iliotibial Band Friction Syndrome (ITB) in 2009. Went to physical therapy and went back to physical therapy in Oct 2014. At that time I took a Ninety-ninety SLR test, Step Down Test, and Ober test (tested positive for all 3 test).

The left leg condition has caused pain in my right leg/knee ( I guess do to compensating).

My knees hurt if I sit for too long and my hydrocele also makes sitting uncomfortable. As a result I spend a lot of time at work standing, which causes bilateral leg/foot pain.

The Carpal Tunnel I just deal with, because again I was told that was just how my hands were going to work/feel going forward.

I feel like a punk complaining about all these little things. My body however won't let me do a lot of the things I used to do. I'm ok with that reality, but the military telling me it wasn't because of them is inaccurate. Working/dealing with physical problems while in the service without complaint is doing me a horrible disservice, despite pushes by leadership to do so.

You are right that the culture of not getting your medical conditions properly seen and treated while in the military is causing many problems for veterans. We are starting to see a change in that culture, but it isn't enough yet.

The VA basically said that they do not have enough evidence of your condition either in the service or currently. If you submitted everything you have, then you may just not have enough. If you do have definite evidence, then you can try to appeal. Opinions from physicians that claim the disease must have developed during your time on active duty could also help if you could get those.

Either in the first box of item 11 or in item 12, be more specific about what you are disagreeing, specifically addressing their reason for denial.

For example, you know that they do not feel there is enough evidence that your TMJ was a ratable service-connected condition and still a serious enough of a disability now, so you can be more specific like this:

"TMJ is service-connected and ratable at 10% due to the Painful Motion Principle. See attached medical records that provide full evidence of painful motion diagnosed while in service and continuing to present day."

They told you why they denied you, so address those reasons exactly. Again, this can be done in item 12 instead of 11 since there is more space in that box.

I posted an update, but it is sort of buried in the middle of the comments, so I am repeating it here. I entered the RAMP on March 27,2018 (some places say March 31 "officially") in the New Evidence lane. I was able to see on vets.gov (not eBenefits) that my RAMP claim had moved into the "evidence gathering" phase on July 5, 2018. On July 12, 2018 I received a phone call from a VA Regional Office (VARO) rep in Waco, TX. He asked a few questions about my claim and then sent it on to the VA in DC that afternoon. From his tone, I think he has recommended that I receive service connection for my prostate cancer. I think that the VA in D.C. takes his recommendation and then begins the process of assigning the rating, etc., and then sends out the notification letter. I'm not really sure how the procedure works, but I think that a regional office (RO) makes the decision and forwards it to DC and the VA in DC sends out the official notifications. Perhaps Dr. Johnson,you can weigh in concerning the normal sequence of events. So, while I have no final decision as of today, you can see that I received a phone call 107 days from March 27,2018.

Hi Doc! I have an ongoing case. I won my initial denial with a NOD for contracting Hep-C in bootcamp from the air injections. I had a liver transplant in 2013 and they gave me only 30% (minimum) for the transplant and have hearing loss in one ear(10%) and periphreal nueropathy (10% in each foot)so I have a total of 60% service connected. I filed another NOD 6 months ago and want to go with the RAMP program. I also have submitted a claim for sleep apnea which I have letters from my VA Dr.s stating it is medically required. My new liver now has NASH and I was wondering if I could get a 10% increase for that which would open the door to unemployability for me. My nueropathy is also 5 times as bad as it was when they first examined me for the original claim... What are your thoughts? Thanks!

You can easily apply for an increased evaluation for your neuropathy (not an appeal) since the VA will definitely increase your rating for conditions that worsen over time. You don't submit an appeal because their original decision was correct based on the symptoms at that time. Instead, submit a new claim for an increased evaluation.

As for NASH, you can only receive a single rating for your liver, whether the 30% for the transplant, or another rating if your symptoms (like NASH) qualify you for a higher rating.

NASH is rated under code 7345:

http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#t

Check your symptoms against the ratings. If they qualify it for a higher rating, then definitely submit a new claim for increased evaluation of the liver.

I was exposed to Agent Orange while serving in the Coast Guard in Thailand during the Vietnam war. The government released in 2010 the information that they did in fact spray Agent Orange at our location. After waiting for a year for a decision, The VA rejected my claim, because I didn't show my service in Vietnam, even though I served in Thailand. I appealed the decision, and was invited to use the ramp program. Last month I check status on ebenefits, and it says closed, not service related, but I never got a letter, or any notification as to why it was refused. What now?

Did you submit the evidence from the government that showed proof of your Agent Orange exposure? The VA will automatically follow the laws regarding the Presumptive List unless you show definite proof that you are an exception. Then you must appeal it to a higher level in order for your case to be reviewed by someone with enough authority to make exceptions. If you did submit full evidence of your exposure to the BVA through RAMP, then your next recourse is to appeal to the US Court of Appeals:

Hi Doc, I have an appeal in progress and decided to opt into the ramp system and trying to decide between higher or Supplemental. I have nerves issues and dignosis with pain in right ankle. 14 times seen active duty. followed up through va 10 yrs post service. right knee meniscus tear with chronic pain major sprain documented 2 active duty with braces issued and again followed up on thourgh va off an on during 10 yrs post service. Degenerative disk c5 medium nerve down right shoulder along with chronic pain down right shoulder. i injured shoulder post service at work 7 yrs later systems complained about and observed to be exactly the same. So my right ankle had proper diagnosis while in service. i have had issues ongoing post service and right as i was filling my claim doctors were able to give actual diagnosis of my other issues with MRI and MRIs with contrast to give the diagnosis regarding the neck, the right shoulder to date is 50% or greater bicep tendon tear, labrum scaring and still tear, possible rotocuff small tear. righ knee meniscus bi later tear and additional abnormality not clearly explained . i have 14 sited medical for the ankle active duty, 2 main events medical documented active duty, neck and shoulder injured on guard status once performing organized PT off base and once working patrol duty on guard wkend. both tech and shoulder seen either through VA and or person chiro. i also filled DBQ's on everything private doctor with a final opinion stated on last page of DBQ's that more likely then not service connected with the dates of injuries listed. so my claim had all my active military medical files, private care fils, MRI reports , current day diagnosis, DBQ's even on fellow soldiers statement to witness accident during PT off base. And was rule non service connected on everything. i'm not sure if i missed something to add to my claim or what and my current lawyer says more then enough evident and timelines nicely with follow up care and diagnosis and that the DDBQ were a nice final touch. possible i missed something? should i go strait to higher level ramp and hope there was an error?

Ok so I elected into the RAMP on 07/18/2018 and my original estimated completion date was 11/07/2018. Last week it was changed to 12/13/2018 (148 days)- 04/07/2019 (263 days). Has anyone else had this same problem?

I left the military in 1992 and I now have been diagnosed with degenerative disk disease. I have never filed a disability claim but have a meeting with a VSO coming up for other disabilities such as knee limitations, shoulder limitations, and had surgery on my right eye. The surgery was conducted during Desert Storm, by civilian doctors and now have blurriness in that eye. The shoulder pain I have had for years and just dealt with it till now and it happened in basic training. My question is, is it worth it to file a claim and what are the chances of winning a claim?

The chances of a successful claim depends on the amount and quality of evidence regarding the service-connection of the conditions. The VA usually does not grant service-connection for conditions that are first diagnosed more than a year after separation unless you can show proof that it was caused by another service-connected condition or it is on the presumptive list.

If you have enough evidence to satisfy service-connection for your conditions, then it is absolutely worth filing a claim.

I have filed for tinnitus and the only C&P I had for it (a few years back) the doctors opinion was service connected. I was denied and have been ever since even though as a Marine Infantry I'm on the presumptive list. Why do they keep turning me down, and what can I do to get the connection?

Shouldn't matter. If you have medical records showing that it has been officially diagnosed, then you can submit those along with evidence of your MOS and the VA should grant service-connection. They just have to see the current diagnosed condition.

I have non-service connection currently for Manic Depression -was initially awarded without a C&P exam in 2014..

This last year, in 2017, I filed for an increase of a physical related service connected disability that I have and it was a success! I went from 20%-50%... My VSO encouraged me to add the non-service connection (Bipolar) as a secondary condition to my claim at the time-during which I had my first C&P exam ever for Manic Depression. It got denied..

Now I never challenged the VA when I was first awarded the non-service connection because I didn’t understand the VA/BVA/CFR’s/Appeals etc. etc.

Anyways, I opted into the RAMP HLR because I feel it was denied based on it was filed as a secondary condition and not as a primary... The C&P examiner clearly stated I have the disease/pulled from my c-file and whatever other databases they use, and clearly stated it ‘IS NOT RELATED’ to my service connected disability...

It’s what she wrote after that I found extremely interesting..

Written by a VA psychologist, and it has been copied WORD for WORD- misspellings and UPPERCASE were done by the examiner...----

“HOWEVER, Veteran self-reported, and records confirmed, that he experienced his first deperssive episodes in the military. It is unclear why a directservice connection for Biplar has been denied twice. The thorough record review conducted today suggests that he was initially treated for depression and impulsivity in the military (see CAPRI DoD). He self-reported a suicide attempt while active duty. Depression is one symptom of Bipolar I disorder. Veteran has, over time, experienced hypomanic episodes. He has had MH treatment consistently since military discharge and the current diagnosis is listed as Bipolar. He stopped working in 2013 secondary to his Bipolar condition. He tried to work part-time in Jan 2018, but stopped work after having incontinence (2/2 back spasms) and feeling completely embarrassedwithsevere depression. Veteran reports current severe functional impairment from his Bipolar, resulting in significant social isolation.Writing provider opines that veteran's Bipolar I disorder is MORE LIKELY THANNOT directly related to his military service (specifically the evidenced mental health treatment in his military service treatment records - see DoD CAPRI for summary of encounters). He appears to be fully credible in hislife story and he self-reported an onset of depression while active duty in Ft Irwin CA.”

If this was written after the second denial, then it is strong new evidence to support your appeal. You needed someone like this to draw these connections in order for the Rating Authorities to grant it.

Have they yet seen and considered this statement? If not, then hopefully the appeal will have a good outcome. If they have already considered this statement and still denied you, what exactly did they list as their reason for denial? They should specify why this statement wasn't enough to convince them, and if they did, then you know what you can address in your appeal.

They denied it after it was written because it was listed as a secondary to my primary service connected disability.. The Psychologist made a note in the C&P report saying that it is medically impossible to be linked to as a secondary... Then after she stated that she wrote the spill you read above, using the CAPITILIZED ‘HOWEVER’ to start the paragraph..

Yet they still denied it...?Saying ‘No new evidence’..

I appealed under the HLR lane in June- my VSO outlined the exact words the report used to submit the claim..

It’s just shocking to me as the key words used were ‘More Likely Than Not’ and still denied ��

Just hoping the HLR reviewer is properly trained and goes over everything.. Here’s hoping��

I see. The examiner has a point about the secondary connection. If you are still unsuccessful, it may be better to try and submit a brand new claim for this as a primary condition instead of secondary. This letter is stronger evidence to support a primary connection, so you may have more success taking that route.

I entered the RAMP 5/18/2018 and the first notenote was made on 9/10 saying my decision would be between 09/05 -10/03 then it changed from 10/03-11/05 now it saying 10/18-12/03 . Why even call it Rapid appeals if they keepExtending the date out . I called the benefit line and ask questions for days and then decided to submit! Now I wished I had not. Prior to submitting documents for RAMP they say to read and ask questions and be sure that’s something you want to do because you can’t pull out of it! Nobody takes me reponsibilty of giving incorrect information . I was told lessThan 59 days or up to 120 days . My RAMP is on day 150

I entered RAMP on 3/27/18 and have seen the same extension of decision dates several times now. As a completion date was close to a week away, it would change by another 30 days. As of today (day 204), the completion date is April 2019! That's a tad more than the 125 days advertised.

I opted in RAMP (HLR) on June 26, 2018. VA acknowledged it as June 29, 2018. My claim went to Preparation For Decision (PFD) on September 4, 2018. On October 4,2018 it moved to Pending Decision Approval (PDA). It moved Pending Notification the morning of October 19, 2018 and had closed that evening. There were no changes to my disability rating on Ebennie, but VA said that the notification was mailed out on October 19th. Therefore, I've been told to not speculate on it being a denial, but rather...wait until I get the BBE/BWE to know!

Good evening, I just received my NARSUM and all my C&P exam results, needless to say the VA doc who did the exam for my primary unfitting condition, spondylithesis. In my opinion did shoddy work. He did not use a Goniometer to measure of my movements pertaining to my lower back issues, although noted he did in the C&P exam paperwork. The measurements he gave would be indicative of a 10% rating, I can barely bend over and walk slightly hunched over and tend to lean to one side and have a drag to my left leg. He noted no radiculopathy, despite having a history of left hip, thigh, and calf pain associated to the back pain and a diagnosis from physical therapy for it. The legal services offered through the Army appear to be less than helpful and I am essentially writing my own appeal an doing Statement in Support of Claim with the VA to try an get a new exam with minimal guidance now and Google. I feel like all hope is lost just considering general "just accept it because its too hard" attitude of everyone I have been dealing with, I am considering hiring a my own lawyer now and getting two separate independent medical examinations from an orthopedic doctor and neurologist to counter the VA examiners perceived incompetence. Thoughts and suggestions are welcome and I live in Colorado if theres anyone worth looking into.

The VA will consider other medical evidence if there is enough of it and it seems to paint a more accurate picture of your condition. If your PT could submit range of motion measurements, that could help.

For your radiculopathy, that needs to be officially diagnosed (not by PT) in order for it to be considered. You may want to consider going to see more physicians to have your conditions more thoroughly diagnosed and recorded. Submitting more plentiful and accurate evidence could help your case.

Thank you, and it was like pulling teeth from my PCM doc but he agreed to refer me for a 3rd MRI, send me to a neurologist, and recommend and EMG test be done. Hopefully, there will be enough evidence to support my claim and make the VA reconsider before I separate.

We started or ramp in jun2018 they keep pushing it back it was first they said it would be done by out 2018 now it has been pushed back to April 2018 the only thing it says is thank you for your ramp we are still adding more things we are losing house house and motorcycles on this we went from 80% to 20 percent becouse some nice va guy said nothing is wrong with my husband that got discharged 20 years ago saying he needs knee replacement but being to young they will not do anything to oh nothing is wrong with you and I hate the waiting game this sucks our house is in foreclosure and bill collectors are calling becouse some doctor that is was nice to drop him and say nothing g is wrong with him I'm so post of my kids have not had Heisman or birthdays in 3 years fro. This stupid shit we went to a out side doctor and they said that is why they put him back down to 20 percent becouse va does not like that will thank you just so up set this I have fought so much for this we where told our money would not change but oh yes it did we went from 2000 a month to 200 and lost everything next is being homeless is this shit does not get CV done fast enough

I signup for the RAMP program. I selected the higher-level lane and I ask for one-time telephonic informal conference the reviewer to discuss some of the issues i disagree with. The VA made a decision without ever allowing me my one-time telephonic informal conference with the reviewer. Can I have the rating decision invalidated because VA did not follow procedures they promised me when I signed up for it? What should I do?

It can't technically be invalidated. They'll just have you appeal it, which would have happened had you not agreed with the decision even with the phone call, unfortunately.

Really, your only next option is to appeal in the Supplemental Claim Lane. Make sure to include whatever you want to say in an affidavit as new evidence. Although it may not be new evidence, they'll at least hear your thoughts without the phone call.

Hello!I submitted a very large FDC claim in June 2018 it all of it was denied except one item. My question is how I should go about appealing or if it isn’t pointless. There are 3 items in particular I don’t understand why it was denied because:

1. the hemorrhoids w fissures were diagnosed while active duty. 2.The tinnitus was denied and my AFSC is on the list of routinely noise exposed 1C1X1. 3. And my Raynauds was denied but I had a buddy statement that explained I was given a jokingly hard time about having poor circulation to my hands and feet when I would complain about how cold they were while working indoors. This one I can understand I guess...4. I was only evaluated for a C&P exam for the tinnitus and my knees! (which I received an increase for a knee). No VA Exams for any of the other items.5. I submitted DBQs for endometriosis, Raynaud’s, and hemorrhoids. I did NOT receive a diagnosis of endometriosis and sjogrens while in service but I had symptoms of these conditions, which average a very long time to diagnose 6+ years. I have records of symptoms of these items during service after what I believe to be the triggering traumatic event—the death of my daughter while I was active duty.

Should I appeal this th traditional route or the RAMP route? And is it pointless to pursue the endometriosis and sjogrens if it wasn’t diagnosed until 2-6 years post service (even if there are records of symptoms following a traumatic event)?

What did the VA say was their reason for denying the first two conditions?

A buddy statement for a condition that was not diagnosed in service is completely powerless. Were you ever seen for the poor blood circulation? Do you have official medical records documenting these conditions and trying to find a diagnosis? If you didn't even get these evaluated during service, it will be probably impossible to get this service-connected now. Same goes for Sjogren's and endometriosis. Even with some evidence, if it wasn't diagnosed within the first year post-service, it will be difficult to prove.

The hemorrhoids and tinnitus, however, you have a much stronger case for. If both were diagnosed during service (or your MOS is on the list), you should be able to get these ones. Definitely appeal. Again, though, the best way to appeal will depend on the VA's exact reasons for denial.

In 1986 while active duty play intramural Football, broke my pelvis in 3 places and was paralyzed for 4 hours. Feelings cam back and was airlifted to Wright Pat. for treatment. No surgery required, but laid up for 6 mths to heal. I had some pain in hips and pelvic region for years, but just dealt with it. In the last 3 years thinks have gone sideways. I had meniscus surgery on right knee and will need surgery on left knee next year. I've had severe hip pain and have seen my Dr on several occasions, with xrays showing cartilage wear. My Dr said that my "gate" is off and felt my pelvic fracture was the cause.

I applied for Va disability and was denied. I hired an attorney and applied. I was invited to the RAMP process and accepted. I found out at the hearing VA didn't have my military medical records ( I uploaded in e-benefits -figures). I provided them to hearing officer. What is your take on this since it is 30 years since my injury.

It is quite common for injuries like yours to cause wear and tear on the nearby joints, thus causing serious conditions in the future.

You definitely have a case here, the VA just needs to be able to have all the evidence of the original injury and evidence of the conditions progression over the years. A letter from your physician clearly noting his opinion that the current conditions are due to the abnormal gate caused by the injury will definitely strengthen your case.

I opted into RAMP in July 2018. I was notified by the VA that my appeal was discontinued at my request on Jan 23rd. After a little panic, I researched and the current status is that The VA cannot track appeals under RAMP and listed my appeal as closed. So now, I can only assume it is still active, and have no way to verify. A call to the Regional Office of the VA gave me the answer that they do not know either. Any suggestions?

It's not a great sign that they have it listed as closed. If you didn't request for it to be closed, then they should still have it open, and I'm hoping that it is just a system error. This may actually be the case since they are transitioning fully into RAMP starting mid-February, so they may be doing some tech work on the system.

However, they should be able to do some research and find out the truth for you at your Regional VA. At least they should be able to tell you who to contact to get the information you need. I would push them a bit more and see if you can't get something from them, even just a referral to someone else to talk to.

I have a VA disability rating on my right hip but because I put most of my weight on my left hip, my left hip joint now is showing signs of disintegration (orthopedic doctor's words). My orthopedic doctor thinks because I'm using my left hip to compensate for my weak right hip, it's adversely affecting my left hip. Is there a compensation code for this issue?

Hi Dr. Johnson, While in the Marine Corps, stationed in Hawaii, my wife kept complaining of me snoring and stopping breathing when I was a sleep. I went to see a doctor (documented in my medical records) and they scheduled me a sleep study. Not sure what it shoed, but the doctor suggested I have my tonsils removed, because If I was placed on a CPAP, I would be medically discharged. I had my tonsils removed , but the medical reason was "re-occuring" tonsilitus, even though I had never been seen for that. I was medically discharged in 2003 (an issue not related to sleep apnea) and upon separation I applied for compensation and treatment for sleep apnea (as well as several other issues). I never went to an exam for sleep apnea, and was denied as they stated I had complained about it, but there was no diagnosis. I went to see a specialist and was on a CPAP (and have been on one since) my denial by the VA. I am considering fighting the VA on this again. My question is, was the VA required to do a sleep study for me during my initial claim? If so can this be retroactive? If not where should I go from here? I am just frustrated I let the VA roll over me years ago, and maybe I should have fought harder.

Technically, conditions must be officially diagnosed BEFORE you can submit a claim for them. Since it hadn't been diagnosed, they were correct to deny the claim. It is not their job during the disability process to diagnose conditions.

Now that it has been diagnosed, you can try to submit a new claim. In order for your claim to have a solid chance, you will need to also submit a NEXUS letter from your physician stating that the current sleep apnea diagnosis was clearly present during service based on the symptoms recorded in your service treatment records.

Hello Dr. Johnson, I have a pronounced limp due to an accident I had back when I was in the military. I'm being compensated for all the things that happened to me because of that accident, but I'm not being compensated for my pronounced limp which has been annotated on many of my orthopedic records. Is there a compensation rating for a limp?

Thanks Dr. Johnson. I broke my L leg in 5 places when I was in the service and one of those breaks had to be fixed by rodding my femur and my hip has been giving me problems ever since. My rating is for arthritis in all 3 joints in my leg. Right now I need a surgery called; a "gluteus maximus transfer." I need this operation because of the following; "a significant amount of his gluteus medius is torn" "Heterotopic bone formation noted superiorly". The doctor who performed my examination noted the I have "a severe limp" and I have "Trendelenburg gait" with "2/5 strength in hip flexion." With this information, do you think any of these conditions are rate able?

Absolutely. As long as you can show proof that all of your current conditions are a direct result of the broken leg and/or the service-connected arthritis, they will also be considered service-connected (secondary). Medical records showing the connection and a NEXUS letter from your physician noting the connection will strengthen your case.